How to stop hot flashes

Why we need to talk about hot flashes

Too many women are missing out on help and support for hot flashes. It’s time we lifted the sense of embarrassment about them, and made dealing with them easier.

Hot flashes are the most common symptom of the menopause transition, also called perimenopause – and you can have them after menopause, when your periods have stopped. “More than 80% of women get them,” says Dr Ann Nainan, Healthily expert. “Some women hardly notice them, while for others hot flashes can be mildly annoying. But for many more women, hot flashes can feel overwhelming and really affect sleep, work, social life – even your bathing routines and what to wear.”

Yet as few as 1 in 5 women with hot flashes see a doctor for help – and that’s despite those women saying their symptoms are severe. “There’s no need to put up with hot flashes if they’re interfering with your life – there’s treatment out there that can help ease them,” says Dr Ann. “There are ways to identify and manage triggers and heat surges so you can avoid them, and self-help strategies to ease the burden when they happen.”

Here’s everything you need to know about finding the hot flash relief that suits you.

What are hot flashes?

• a hot flash is when you feel a sudden wave of heat or warmth in your body, often with other symptoms like sweating. It can feel manageable or even unbearable – this varies between women
• it might be brought on by ‘triggers’ such as hot weather, eating spicy food or working up a sweat when you’re out for a run. But sometimes there might be no obvious reason for a hot flash coming on – every woman is different

When do hot flashes kick in?

• hot flashes usually start during your perimenopause (the transition stage leading up to menopause, which is your last period). The perimenopause can be thought of in 2 parts:
  • early transition, when you're still having periods, but you may notice they’re starting to become less regular. Around 40% of women in this stage will get hot flashes
    – late transition, when you may find you start to have more than 2 months in between periods, leading up to your final period. Around 60% to 80% of women have hot flashes by this time
• in some women, hot flashes don’t start until the post-menopause stage (the time after your last period)
• hot flashes can also happen if you go through early menopause (that’s menopause before you’re 45)

What causes hot flashes?

Experts aren’t 100% sure what causes hot flashes (also known as vasomotor symptoms), but here’s the thinking:

• the hormonal changes you go through in the menopause reset the part of your brain (your hypothalamus) that regulates your body temperature
• there’s increasing evidence that certain messengers (neurons) in your brain also play a part in these temperature changes
• as a result, a really small increase in temperature (like when it’s a warm, sunny day) can make you feel like you’re overheating

Watch this video from a women’s health expert at Mayo Clinic to find out more about hot flashes.

What can trigger hot flashes?

There are lots of things in your day-to-day life that can trigger hot flashes. They include:

• hot weather
• caffeine
• alcohol
• spicy foods
• tight clothing
• stress
• activity

Who’s most likely to get hot flashes?

There are certain risk factors that can make you more likely to have hot flashes:

• being overweight or obese can mean you may get more severe hot flashes, and you may get them more often
• being a smoker – it’s thought that smoking increases hot flashes by lowering your estrogen levels. Studies have shown that estrogen levels are lower in smokers than in non-smokers
• African-American and Hispanic women report more hot flashes, and have them for more years, than White and Asian women. Why the difference? In one large study that followed almost 3200 women over 6 years, researchers said it may be down to differences in the way African-American people and White people experience temperatures. But more research is needed to fully understand what’s going on
• your genes – research has found that women who have a variation of a certain gene (it’s called TACR3 tachykinin receptor 3) are more likely to get hot flashes than those who don’t have the gene variant, but it’s not currently possible to get tested to see if you have these genes

Hot flashes symptoms

• you can have a hot flash during the day or at night when you’re asleep (these are called ‘night sweats’)
• how often you get hot flashes varies – you might have less than 1 a day to as many as 1 every hour during the day and night
• a hot flash can last anywhere from 30 seconds to 5 minutes
• as time goes on, your hot flashes may become milder and happen less often

Here’s what can happen when you have a hot flash. You may get all or some of these symptoms:

• a sudden feeling of warmth that starts on your face and chest and may quickly spread throughout your body
• sweating, mostly on your upper body
• reddening of your skin – they’re sometimes called ‘hot flushes’ because of that flushed appearance
• rapid heartbeat
• after the hot flash you might feel a cold chill, have shivering and feelings of anxiety

How long do women have them?

• you might get hot flashes for up to 8 years
• but in some women, they may go on for more than 10 years

What does a hot flash feel like?

Here’s what some women have said about their experiences of hot flashes:

Carole was 52 when she got her first hot flash. She says: “I know when one is coming on because I get an anxious feeling, like a mini panic attack. I know in about 60 seconds I will feel hot flushing, and in 120 seconds it will be over. Counting to 120 gives me a sense of how long I need to wait and gives me a sense of calm.”

When Sarah started getting a hot, prickly feeling in her neck and face she initially thought it was panic attacks. "Sometimes I would sweat. And my heart would race," she says.

Lisa, 56, is post-menopausal and she says her hot flashes are still “ferocious.” She explains: “If I drink water, I get a hot flash. If I eat anything salty, sweet, caffeine, alcohol, forget about it.”

Fay was 46 and had just started a new job when she got her first hot flash. “For about a year, things were tolerable, although I had to change my route into work as I couldn’t cope with the journey,” she says. “I’d get on the tube (train) already dripping with sweat and the anxiety would kick in. The new route was longer but more bearable.”

“I’d be sitting at work and suddenly feel an unpleasant warm sensation moving up through my body,” says Jo, 50. “Sometimes it happened when I felt stressed, at other times it came on for no reason. It would last a few minutes but felt uncomfortable and embarrassing – particularly if I was in a meeting. After a year of this (I was still in my late 40s so in denial that this could be related to menopause), I’d had enough so I saw my doctor who prescribed HRT. It’s really helped me, the hot flashes have gone and I have my confidence back.”

British author and journalist, Rose George, says of her menopausal night sweats: “I woke up in the night boiling hot and pouring sweat. I use ‘pouring’ deliberately because I was drenched. Sometimes, I woke up freezing because I was covered in cold sweat. Every athlete knows to change clothes as soon as possible because sweat chills so fast. Every night, it was as though I was running several races. I woke up fatigued, stinking and angry.”

When to see a doctor

Make an appointment with your doctor if:

• you’re not sure whether you’re having hot flashes or if it’s something else
• hot flashes are affecting your daily life and/or your ability to get a good night’s sleep. Your doctor can prescribe medication that can help relieve your hot flashes
• you are losing weight, feel unwell, have fatigue along with the hot flushes, or persistent drenching night sweats

If you’re not sure whether to see a doctor, use our Healthily Smart Symptom Checker to work out your best next steps.

How are hot flashes diagnosed?

Your doctor can usually make a diagnosis based on your description of your symptoms.

You might need to have blood tests to check whether you’ve started the menopause or if it’s something else causing your hot flashes.

Self care – hot flash remedies

How to stop hot flashes fast? While you can’t cure hot flashes, you can definitely ease them. You may find it helpful to follow these self-care tips to help you cope whether you’re at home, at work or you’re on the move:

• avoid your triggers – if you get to know what tends to bring on your hot flashes, you may be able to help by avoiding those triggers
• layers are your friend – go for layers of clothing that you can take off when you feel hot and put on if you feel cold
• pick your fabrics wisely – when it comes to clothes and underwear, choose breathable cotton or moisture-wicking fabrics that draw sweat away from your body
• keep a fan to hand and try other cooling devices/accessories, such as cooling wristbands, necklaces or neck wraps
• try a cooling gel mattress topper – you put this between your mattress and top sheet, and it pulls heat away from you when you’re in bed
• make lifestyle changes – take steps to cut down on, or quit smoking, and lose weight if you need to
• take steps to reduce stress – while it’s unrealistic to cut stress out of your life, learning to manage it better may help with your hot flashes

Hot flashes at work – how to talk to your employer

Hot flashes at work can be really hard going. Here are some tips on dealing with them in your work life:

• talk to your line manager – “You might feel embarrassed about discussing your hot flashes with your manager but it’s their job to help you be your best at work. Book in a meeting with them. In doing so, you’ll have time and space to talk about your hot flashes and how they’re affecting your work,” says Dr Ann
• be prepared – ahead of your meeting, it’s a good idea to write down your symptoms, how they’re affecting you and what practical solutions you think might help in your workplace – whether that’s switching to a desk near a window or arranging meetings for later in the day or first thing in the morning, when it’s cooler
• seek out colleague support – “Some women prefer to keep their hot flashes private. For others, opening up to a colleague you trust can really help,” says Dr Ann. “They may be having menopausal hot flashes themselves or have a partner or family member who’s going through them. It can make all the difference to have a supportive colleague who understands what you’re experiencing”

Treatment for hot flashes

Depending on your symptoms and how they affect you, your doctor might prescribe you:

Hormone therapy

One of the main treatments for hot flashes in menopause is hormone replacement therapy (HRT) – it works by replacing the hormones that are declining in your body as you go through the menopause transition. Here’s what you should know:

• if you’ve had a hysterectomy to remove your womb (uterus), you can take estrogen on its own. If you still have your womb, you should take estrogen with progesterone to protect against endometrial cancer
• hormone therapy isn’t suitable for everyone, and some women may need non-hormonal treatment (see below). Hormone therapy may not be suitable if you have a personal history or high risk of conditions, including:
  • breast cancer
  • heart disease
  • blot clots
  • stroke

Antidepressants

Some types of antidepressant can ease hot flashes, and may be prescribed even if you don’t have depression, usually at a low dose.

• paroxetine is the only non-hormonal treatment for hot flashes that has been approved by the US Food and Drug Administration (FDA)
  it’s a type of antidepressant called a selective serotonin reuptake inhibitor (SSRI)
  it’s not suitable if you’re taking tamoxifen for breast cancer treatment as it can alter how your breast cancer treatment works
• other antidepressants that could benefit hot flashes include venlafaxine, desvenlafaxine, citalopram and escitalopram

Anti-seizure medications

• certain drugs that are usually used to control seizures can also help with hot flashes in some women
• these include gabapentin – some research found 1 dose of gabapentin given at bedtime could relieve nighttime hot flashes that can disrupt sleep. In the study, if women taking gabapentin did have night sweats, they went back to sleep more easily

What about alternative therapies for hot flashes?

You might be interested in alternative or complementary therapies for coping with hot flashes. We look at the evidence for them:

• cognitive behavioral therapy (CBT – there’s some evidence that this psychological therapy can help manage hot flashes. Research has shown that it may reduce how severe your hot flashes feel, but not how frequently you get them
• hypnosis – some research has found that hypnotherapy with a qualified practitioner can be helpful for relieving hot flashes, but more research is needed
• vitamin E – if your hot flashes are mild, some doctors recommend a vitamin E supplement. At low doses it doesn’t tend to cause side effects, but there isn’t much evidence to show that this helps

There are other supplements and herbal remedies that are believed to help with hot flashes – but right now there isn’t enough scientific evidence to say whether they work and/or whether they’re safe to treat hot flashes. These include:

• black cohosh
• DHEA (a supplement of the hormone dehydroepiandrosterone)
• dong quai (a herb used in traditional Chinese medicine)
• evening primrose
• ginseng
• St. John’s wort
• omega-3 fatty acids
• red clover
• flaxseed
• isoflavone supplements

You should always speak to your doctor before taking any herbal supplement to help with your hot flashes.

Your health questions answered

Q. Why are hot flashes worse at night?

“There isn’t any concrete evidence to show that nighttime hot flashes are worse than those you get during the day – but these night sweats can be really distressing because they can wake you up from your sleep. And continued disrupted sleep can bring with it a whole host of problems,” says Dr Ann.“You might find it helpful to follow some of the self-care tips on staying cool at night or speak to your doctor about what treatment is available to you.”

You might find that night sweats wake you earlier in your sleep than later – some research has found that they’re more common during the first 4 hours of sleep than later on in your sleep cycle. It seems that rapid eye movement (REM) sleep (the bit when you do most of your dreaming) somehow protects you from hot flashes and from waking up from them.

Q. Could there be another reason for my hot flashes?

A. “It’s not only the menopause that can bring on hot flashes. There are other conditions/medications that can cause them,” says Dr Ann. These include:

• thyroid disease
• infection
• having breast cancer treatment
• having prostate cancer treatment
• and, rarely, some types of cancer

If you’re not sure what’s causing your hot flashes or night sweats, speak to your doctor.

What’s new?

A new type of non-hormonal drug called fezolinetant is being reviewed by the FDA in the US to see if it could be a suitable treatment for hot flashes in women going through the menopause. The treatment works by blocking the neurons that play a part in resetting your internal thermostat (which is what leads to hot flashes). So watch this space.

Medical disclaimer: Quotes are the views of the authors of these statements, and aren’t necessarily the views of Healthily, its medical team or writers.